Fifteen Years of Equality? Disability in Australia after the UN Convention of the Rights of Persons with Disabilities 

The Convention On The Rights Of Persons With Disabilities. A large room with many rows of curved desks. A range of people are facing a stage, with many seated, including a person sitting in a wheelchair in the foreground.
The adoption of the Convention On The Rights Of Persons With Disabilities (CRPD) in 2006, which entered into force in 2008. Source: UN Department of Economic and Social Affairs

Fighting against the segregation of people with disabilities, giving a more meaningful voice to people with disabilities, and making sure the NDIS doesn’t become a (more) broken funding model. These were some of the issues discussed during a fascinating panel discussion last night that was organised by the UNSW Disability Innovation Institute to mark the International Day of People with Disability.

The discussion explored what progress has been made in the fifteen years since the adoption of the UN Convention of the Rights of Persons with Disabilities – or lack thereof. The panel included June Riemer, Dr Alastair McEwin, Rosemary Kayess, Fiona Mckenzie and Prof Julian Trollor, and was facilitated by Nas Campanella.

The CPRD played a major role in shifting the perception of people with disabilities from the subjects of medical treatment and charity, to full members of society with human rights.

One of the strongest themes from the discussion was the need to normalise and support people with disabilities to participate in all aspects of life and to end segregation. The content of the Convention remains relevant – and a lot of it remains unrealised:

The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.

UN Convention on the Rights of Persons with Disabilities (CRPD) Article 1

As the incoming Disability Discrimination Commissioner Rosemary Kayess summarised, “we’ve got to stop focusing on the diagnosis and start focusing on the processes to support people to participate… Let’s stop with the catchphrases and talk about disability like grown-ups.”

Fifty Years on, the Whitlam government’s Community Health Program is more relevant than ever

On Friday I had the privilege of attending a forum Celebrating the Whitlam Community Health Program: Lessons for the Future and participating on a panel at the Whitlam Institute.

The forum was the culmination of an ARC-funded Project looking at Contemporary lessons from a history of Aboriginal, women’s and generalist community health services in Australia 1970-2020, which involved more than a dozen investigators from nine universities and partner organisations.

  • Minister Butler speaking at a podium. A large image of Gogh Whitlam is behind him.
  • Associate Professor Tamara Mackean speaking at a lectern. A large photo go Gogh Whitlam is behind her.
  • Several people seated at the front of a room. Slide projected says "Australian women's health movement, centres & services: 1970s-2020s"
  • Dr Toby Freemans speaking at a podium with a large photo of Gogh Whitlam behind him.

The Community Health Program

The Community Health Program was established in 1973 and within three years it had funded over 700 projects, including community health centres, Aboriginal medical services, and women’s health centres.

Communities must look beyond the person who is sick in bed or who needs medical attention. The (Hospitals and Health Services) Commission will be concerned with more than just hospital services. The concept and financial support will extend to the development of community-based health services and the sponsoring of preventive health programs. 

Gough Whitlam, in a 1993 keynote address to the Australian Community Health Association’s National Conference in Adelaide

Even though the program was gouged by later governments many of the services funded still exist. For example I’ve worked with the Liverpool Women’s Health Centre this year, which was founded by a collective in 1975 and funded through the CHP.

The vision of the CHP remains relevant today: ensuring that people can have access to relevant, meaningful multidisciplinary care in the community. When the CHP was conceived in the early ’70s it sought to meet preventive care needs, to address inequalities, to reduce demands on hospital emergency departments, and tackle rising rates of chronic disease – issues which we have gone backwards on since.

The presentations and panel discussions highlighted that while the community health sector remains dynamic, Commonwealth engagement with the sector has been erratic. There’s a need to return governance to communities, reduce the variability in services offered by community health between states and regions, and to return to block funding rather than project funding. Primary Health Networks are well placed to tackle these issues, and to foster the kind of resilient local service systems that we’ll need to address environmental, social and economic shocks in the near future.

Thanks to all involved for a very thought-provoking afternoon.

Project team

Researcher and Project Manager

Dr. Connie Musolino, University of Adelaide.

Chief Investigators

Partner Investigators

  • Patricia Turner AM, CEO of the National Aboriginal Community ControlledHealth Organisation (NACCHO).
  • Denise Fry, Sydney Local Health District.
  • Paul Laris, Paul Laris and Associates.
  • Tony McBride, Tony McBride & Associates.
  • Jennifer Macmillan, La Trobe University.

Researchers and Students

  • Dr. Helen van Eyk, University of Adelaide.
  • Dr. James Dunk, The University of Sydney.
  • Abdullah Sheriffdeen, Flinders University.
  • Jacob Wilson, Flinders University.

“Rich people get lots of it. Poor people don’t get any of it!”: Fifty years of tackling the Inverse Care Law

I was fortunate to have the opportunity to speak at the South Western Sydney Local Health District Primary & Community Health Research & Innovation Showcase on 6 September 2023 about 50 years of the inverse care law. My slides and references are below.


  • “Rich people get lots of it. Poor people don’t get any of it!” Fifty years of tackling the Inverse Care Law
  • “The availability of good medical care tends to vary inversely with the need of the population served… This inverse care law operates more completely where medical care is most exposed to market forces and less so when such exposure is reduced” Tudor Hart, 1971
  • “To the extent that health care becomes a commodity it becomes distributed just like champagne. That is rich people get lots of it. Poor people don’t get any of it.” Tudor Hart, 1973
  • Effect of different approaches to reduce health inequalities. Shows that proportionate universalism has an important role to play in achieving gains in life expectancy.
  • The inverse care law persists in Australia
  • Provision and use of health care in the lowest and highest SES areas
  • There are multiple causes of, and forms of, disadvantage… …but income inequality is a manifestation that cuts across all of them.


ABS. (2019, April 29). 4364.0.55.014—National Health Survey: Health Literacy, 2018. Australian Bureau of Statistics.

AIHW. (2021). Health Expenditure Australia 2019-20., AIHW, Australian Government. Australian Institute of Health and Welfare.

AIHW. (2023). Mortality Over Regions and Time (MORT) books. Australian Institute of Health and Welfare.

Bates, S., Harris-Roxas, B., & Wright, M. (2023). Understanding the costs of co-commissioning: Early experiences with co-commissioning in Australia. Australian Journal of Public Administration, online first.

Furler, J. S., Chondros, P., Young, D. Y., Harris, E., Powell Davies, P. G., & Harris, M. F. (2002). The inverse care law revisited: Impact of disadvantaged location on accessing longer GP consultation times. Medical Journal of Australia, 177(2), 80–83.

Harris, E., & Harris, M. F. (2022). An exploration of the inverse care law and market forces in Australian primary health care. Australian Journal of Primary Health.

Harris-Roxas, B., & Sturgiss, E. (2023). Equity in primary health care provision: More than 50 years of the inverse care law. Australian Journal of Primary Health, 29(2), i–ii.

Lewis, V. J., Macmillan, J., & Harris-Roxas, B. (2022). Defining community health services in Australia: A qualitative exploration. Australian Journal of Primary Health.

NCCDOH. (2013). Let’s talk: Universal and targeted approaches to health equity. National Collaborating Centre for Determinants of Health.

Tudor Hart, J. (1971). The inverse care law. The Lancet, 7696, 405–412.

Turrell G, Stanley L, de Looper M, & Oldenburg B. (2004). Health Inequalities in Australia: Morbidity, health behaviours, risk factors and health service use (Health Inequalities Monitoring Series No. 2). Queensland University: AIHW.

University of Glasgow. (2023). The Scottish Deep End Project.

Watt, G. (1998). Not Only Scientists, but Also Responsible Citizens. Journal of the Royal College of Physicians of London, 32(5), 460–465.

Watt, G., Brown, G., Budd, J., Cawston, P., Craig, M., Jamieson, R., Langridge, S., Lyon, A., Mercer, S., Morton, C., Mullin, A., O’Neil, J., Paterson, E., Sambale, P., Watt, G., & Williamson, A. (2012). General Practitioners at the Deep End. Occasional Paper (Royal College of General Practitioners), 89, i–40.

“Understand who this person was, who they are, their challenges, their triumphs”: What leads to brilliant aged care?

Even though many aged care services don’t provide the care that older people and carers need and want, some do it much better than others. Why?

That’s the question colleagues from WSU, UNSW, SESLHD, SWSLHD, RCSI and I explored in an open access article that explores these questions, led by Associate Professor Ann Dadich.

Rather than focusing on the substantial and systemic problems facing aged care, this study examined brilliant aged care — practices that exceeded expectation.

There are many insights into what can lead to brilliant aged care, which can be broadly categorised into:

  • deep understanding of the older person
  • more than a job
  • innovative practices
  • permission to reprioritise.

Some of the best insights came from the artefacts that people were asked to bring to the interview, which were items (e.g. photos, items, artworks or other objects) that reflected brilliant aged care for them. These artefacts opened up new lines of discussion and new ideas, for example:

“people in the late stages of dementia are like an oyster, one of the ugliest, kind of gnarled shells you could possibly think of. There are so many beautiful shells in the world. The oyster isn’t one of them and yet when you open it up, it has this extraordinary little pearl inside it and that’s what we need to find in every older person. Every older person, no matter … what their state of health or wellbeing, still has that pearl that is that beautiful human being inside them and it’s our job, not their job, it’s our job to open that up and find that pearl.” (Grace)

There’s a lot more in the open access article – take a look.

Dadich, A., Kearns, R., Harris-Roxas, B., Ni Chroinin, D., Boydell, K., Ní Shé, É., Lim, D., Gonski, P., & Kohler, F. (2023). What constitutes brilliant aged care? A qualitative study of practices that exceed expectation. Journal of Clinical Nursingonline first

The Deluge

The Deluge book cover

Stephen Markley has crafted a well-written, thousand-page sprawling multi-person narrative about the havoc we’ll face over next two decades due to climate change.

We follow a range of characters including a larger-than-life climate activist, a small group devoted to resisting extractivism through violence, a curmudgeonly climate scientist, a poor Midwesterner with a history of addiction, a modeller with autism, a PR shill for carbon polluters, and perhaps a dozen more characters. As the book unfolds we witness increasing climate chaos and political mayhem, fascism, collective action, gradual inadequate political change.

I liked this book – and I think it’s important – but it’s difficult, weighty reading. The vision of what the next two decades will hold seems accurate, chilling, and is frankly emotionally battering. Markley clearly understands climate science and has devoted considerable effort to imagining the unravelling of politics as climate disasters occur more frequently and vested interests dig in.

A major weakness of the book is that it focuses entirely on the perspective of Americans. While many of the horrifying impacts of the climate catastrophe described in the book affect the Global South most, we never follow the perspective of those who live beyond the U.S.’ borders. This is perhaps understandable. Markley is writing from perspectives that he knows and understands, primarily for an American audience. Unfortunately in doing so he perpetuates the kind of American egocentrism and exceptionalist thinking that has driven much of the climate catastrophe that we face.

In writing this review I’ve realised that the book could perhaps be 200-300 pages shorter. Many characters’ perspectives are not critical to the overall plot, and entire strands remain unresolved. Some of this meandering writing asists world-building, and the lack of resolution enhances the overall realism (do any of our lives have neat endings?).

There is a significant through-line about whether the urgency of the climate emergency requires violent direct action, or if social movements are the only way the necessary change can be achieved. Markley clearly thinks the latter, and I suspect he’s right. He explores the moral and interpersonal costs of this kind of political violence, which are some of the more interesting aspects of the book.

The Deluge is a powerful work of foresight-infused fiction, and if you’re not convinced of the urgency of climate action by the end you haven’t been reading properly. A stark future lies ahead, and sooner than we think. For these reasons I recommend it to others, but I’m reluctant to return to it myself.

Also posted on Bookwyrm

Equity in Primary Health Care Provision: More than 50 years of the Inverse Care Law

I guest edited a special issue of the Australian Journal of Primary Health with Dr Liz Sturgiss that reflects on more than 50 years of the Inverse Care Law.

The Inverse Care Law was first coined by Julian Tudor Hart in 1972 to refer to availability of good medical and social care varying inversely with the needs of the population served .

As we note in the editorial:

…we cannot forget the importance of income inequality as one of the primary manifestations of disadvantage. Poverty remains one of the principal determinants of how the inverse care law plays out in primary health care and it is a cross-cutting issue that affects all disadvantaged groups to varying degrees. All approaches to improve the access to primary care would benefit from specific attention to how the needs of those living in poverty are served.

The special issue includes a range of articles on the Inverse Care Law itself, Aboriginal and First Nations health, care for transgender people, access for people from culturally diverse backgrounds, and general practice. Most are open access – please take a look.


Harris-Roxas, B., & Sturgiss, E. (2023). Equity in primary health care provision: more than 50 years of the inverse care law. Australian Journal of Primary Health, 29(2), i–ii.
Tudor Hart, J. (1971). The inverse care law. The Lancet, 7696, 405–412.

Still time to submit your article: Equity in Primary Health Care Provision – More than 50 years of the Inverse Care Law

Dr Liz Sturgiss and I are guest editing a special issue of the Australian Journal of Primary Health on Equity in Primary Health Care Provision – More than 50 years of the Inverse Care Law.

There’s still time to submit your EOI for inclusion in the special issue, in the form of abstracts are due by 30 March 2022. Full submissions are due by 15th July 2022.

Key areas

We welcome submissions of primary research as well as commentary and review papers from anywhere in the world. We particularly seek submissions based on:

  • Comprehensive primary health care for specific populations, including
    – prison populations
    – Aboriginal and Torres Strait Islander health and First Nations
    – culturally and linguistically diverse communities
    – people living in poverty
    – populations experiencing homelessness and unhoused people
    – rural and remote health
  • Models of care and health services research
  • Team based care and exploration of scope of practice
  • Policy innovations and funding models
  • Community-based responses to the needs of marginalised and oppressed groups

More information on the Australian Journal for Primary Health website.

Evaluation of ‘Shisha No Thanks’ – a co-design social marketing campaign on the harms of waterpipe smoking

An important paper from our Shisha No Thanks! project, led by Lilian Chan, has been published:

This is one of the first published evaluations of a health promotion intervention targeting young people to address the growing global trend of waterpipe smoking. It makes a timely and important contribution that demonstrates that co-design social marketing campaigns can raise awareness of messages about the harms of water pipe smoking among young people of Arabic speaking background. 

It’s open access and free to access.


Chan, L., El-Haddad, N., Freeman, B., MacKenzie, R., Woodland, L., O’Hara, B. J., & Harris-Roxas, B. F. (2022). Evaluation of ‘Shisha No Thanks’ – a co-design social marketing campaign on the harms of waterpipe smoking. BMC Public Health, 22(1), 386.

Speaking COVID-19: Supporting COVID-19 communication and engagement efforts with people from Culturally and Linguistically Diverse Communities

The pre-print version of this paper written with my colleagues Holly Seale, Anita Heywood, Ikram Abdi, Abela Mahimbo, Ashfaq Chauhan and Lisa Woodland is available. It provides timely evidence about the need for the development of COVID-related resources, messages and financial support for culturally diverse communities.

N.B. it’s a preprint so it hasn’t been through peer review yet.

Moon Towers

I read an article on lost objects. In it they briefly allude to moon towers, or moonlight towers, which I’d never heard of. These were 50-70m towers designed to illuminate areas up to 1km diameter areas.

The only remaining ones are in Austin, though their origins were grim:

The initial construction of these towers was in part a reaction to a local serial killer dubbed the Servant Girl Annihilator, who terrorized Austin between 1885 and 1886

Party At The Moon Tower